Lipedema: Clinical stages and compression recommendations
| Stage | Characteristics | Compression recommendations |
|---|---|---|
| 1 | Smooth skin, homogenous increase in subcutaneous tissue, cool skin in certain areas Subdermal pebble-like feel due to underlying loose connective tissue fibrosis Small nodules Edema reverses with elevation Circadian rhythmicity | Micromassage compression garment 10–20 mm Hg as needed |
| 2 | Irregular or uneven skin surface (skin dimpling) Palpable nodules (may be walnut size) Nodular change of subcutaneous tissue Tissue begins to hang off the arm, wrist cuff sign Reversible or irreversible edema Moderate to severe fibrosis Circadian rhythmicity | Micromassage compression garment 20–40 mm Hg if pain, swelling, or heaviness is present |
| 3 | Tender subcutaneous nodules Pronounced increase in circumference with loose skin and tissue Bulging protrusion of fat mainly at inner and outer thighs and knees Marked sclerosis and fibrosis Often concomitant lymphedema with a positive Stemmer sign (lipolymphedema) | Micromassage compression garment 20–40 mm Hg as tolerated if pain, swelling, or heaviness is present May have to layer different garments |
Based on information from references 4,5,43.